The effects of donor age on the outcome of penetrating keratoplasty in adults.

OBJECTIVE: The purpose of the study is to determine whether there is a higher incidence of complications in adult patients receiving corneas from pediatric donors compared to those receiving corneas from adult donors. DESIGN: The design is a follow-up of two matched cohorts. PARTICIPANTS: The outcome of penetrating keratoplasty in 29 adult patients (age 20 years of age and older) receiving pediatric donor corneas (range, 0-5 years) was compared to that of 29 control patients matched for recipient age and diagnosis who received adult donor corneas (range, 40-70 years). INTERVENTION: Chart review was performed. MAIN OUTCOME MEASURES: Graft rejection, postoperative keratometry, postoperative refractive cylinder, postoperative intraocular pressure, and graft failure due to rejection were measured. RESULTS: One or more allograft reactions occurred in 11 (37.9%) of 29 patients who received pediatric donor corneas compared to 2 (6.9%) of 29 patients who received adult donor corneas (P = 0.005, chi-square). There were a total of 20 rejection episodes in patients receiving pediatric donor corneas compared to a total of 5 rejection episodes in patients receiving adult donor corneas. The average postoperative keratometry was 46.1 diopters for the pediatric donor group and 44.0 diopters for the adult donor group (P = 0.03). There was no statistically significant difference in average refractive cylinder (P = 1.0), intraocular pressure (P = 0.26), or the incidence of graft failure due to rejection (P = 1.0) between the two groups. The average follow-up time for clear grafts was 58.3 months in the pediatric donor group and 59.9 months in the adult donor group. CONCLUSIONS: The incidence of allograft reactions and the postoperative corneal curvature is greater in adult eyes undergoing penetrating keratoplasty with young donor corneas compared to those undergoing penetrating keratoplasty with older donor corneas. There was no difference in the incidence of graft failure due to rejection between the two groups.

Diagnosis of Aspergillus keratitis in vivo with confocal microscopy.

Confocal microscopy provides a new, noninvasive way of imaging the human cornea in vivo. One of its most important clinical uses is the diagnosis and management of infectious keratitis. The authors used tandem scanning confocal microscopy to image the corneas in two culture-proven cases of Aspergillus keratitis. Fungal hyphae were imaged as high-contrast filaments 6 microns in diameter from 60 to 400 microns in length. Confocal microscopy may be a fast and safe diagnostic tool in determining the presence of fungal hyphae in vivo within the human cornea.

A clinical comparison of the efficacy of an electromechanical flossing device or manual flossing in affecting interproximal gingival bleeding and plaque accumulation.

This one-month clinical trial was designed to compare the effect of an electromechanical flossing device and manual flossing on reducing interproximal gingival bleeding and plaque accumulation in a cohort of 60 healthy adults. After baseline evaluation of interproximal gingival bleeding, soft tissue trauma and plaque, patients were randomly assigned to one of the two experimental groups, given flossing instructions, and had their teeth cleaned. At 30 days all three clinical parameters were again evaluated. The results showed a reduction in GI from baseline to follow-up in each group. This effect is significant (p<0.0001) in the analysis of variance. There was no overall difference in the groups (p=0.93). There was no difference in the reduction in GI from baseline to follow-up between the two groups (p=0.91); interaction). As with the GI, there was a significant reduction in PI from baseline to follow-up in each group (p<0.0001). There was no overall difference between the groups (p=0.24). There was no difference in the reduction in PI from baseline to follow-up between the two groups (p=0.59; interaction). No soft tissue trauma was noted at the baseline examination or at the follow-up examination after 30 days.

Diagnosis of Acanthamoeba keratitis in vivo with confocal microscopy.

We present eight cases of Acanthamoeba keratitis. In each case; the Acanthamoeba organisms were visualized in the epithelium and anterior stroma using tandem scanning confocal microscopy. The organisms were highly reflective, ovoid, and were 10-25 microns in diameter. The Acanthamoeba organisms in the human corneas were identical in size and shape to Acanthamoeba organisms on an agar plate visualized with the same confocal microscope. Confocal microscopy is a useful method for identifying Acanthamoeba organisms in vivo within the corneal epithelium and anterior stroma.

Ocular aspergillosis isolated in the anterior chamber.

BACKGROUND: In all cases in which ocular involvement has been reported in endogenous aspergillosis, the posterior segment of the eye was involved. METHODS: The authors examined a patient who had been intubated and treated with corticosteroid therapy for status asthmaticus and in whom a mass later developed in the anterior chamber of the right eye. RESULTS: Computed tomography showed a solitary lesion in the left lower pulmonary lobe and multiple brain lesions that enhanced with contrast. Aspergillus fumigatus was cultured from the endotracheal tube. However, ocular and blood cultures were negative, as were the results of a bone marrow biopsy, lung biopsy, and anterior chamber paracentesis. Disseminated aspergillosis was confirmed when a biopsy of the anterior chamber mass was performed, and results of histopathologic examination showed the presence of hyphae. The patient responded to a regimen of antifungal drugs. CONCLUSION: This is the first known reported case in which the diagnosis of disseminated aspergillosis was confirmed with biopsy of an anterior chamber mass. This case demonstrates that Aspergillus organisms may disseminate to the anterior chamber of the eye without involving the posterior segment.

Iris crystals in chronic iridocyclitis.

Iris crystals in three patients with idiopathic iridocyclitis, Fuchs' heterochromic iridocyclitis, and iridocyclitis associated with systemic pseudolymphoma are described. Two patients had iris crystals in one eye, and the other patient had bilateral involvement. The number of iris crystals in each eye ranged from one to multiple crystals. Iris crystals were minute and refractile and glistened with light; they have previously been reported to be Russell bodies and to be associated with hypergammaglobulinaemia. However, two of the patients, who underwent serum protein electrophoresis, did not demonstrate hypergammaglobulinaemia.